Course Of Healing Research Articles

Evaluating healing pattern after fibrotomy and myotomy followed by grafting with buccal fat pad and collagen in oral submucous fibrosis patients: a case series

This study was conducted to assess the healing pattern of buccal fat pad and collagen as intraoral graft post fibrotomy and masticator myotomy in oral submucous fibrosis patients. The study was conducted on 20 patients with reduced mouth opening due to oral submucous fibrosis (Khanna and Andrade classification grade 3 and 4 a), randomly divided into 2 groups. In one group, buccal fat pad was harvested and in other group only wet bovine collagen sheet was applied as surgical dressing in the intra-oral wound after fibrotomy and masticator myotomy. Healing pattern of both as graft material were compared based on clinical findings. Healing occurs following epithelialization of the buccal fat pad which gradually takes the color of the buccal mucosa. Xenogenic collagen offers better coverage of the surgical wound but degenerates itself in the course of healing. The covered wound epithelializes without scar tissue formation and patients experience less symptoms during healing phase.

5: 3D Transglutaminase Fibronectin Hydrogel Therapy Improves the Healing of Chronic Irradiated Porcine Skin Wounds

Purpose:Chronic irradiated wounds are characterized by a delayed and incomplete healing course. Currently, there are no therapies directed at the deficient or dysfunctional biology associated with cutaneous radiation injury. We have previously demonstrated that fibronectin is a key extracellular matrix glycoprotein known to be significantly downregulated in radiation-damaged skin. We further identified that an enzymatically crosslinked hydrogel is a suitable construct for incremental fibronectin release in vitro and in murine wound models. Our present objective was to investigate the design of this fibronectin hydrogel dressing for the treatment of irradiated wounds in the clinically relevant porcine irradiated wound model.Methods:We created a chronic irradiation skin injury model in female Yucatan minipigs. Two 1-month-old minipigs underwent irradiation of the right dorsolateral neck region for 5 consecutive days in 5.5 Gy fractionated doses for a total of 27.5 Gy. Following irradiation, the minipigs were allowed 6 weeks of recovery to enable chronic irradiation skin changes to develop. After recovery, nine 1 cm x 1 cm full-thickness wounds were created in the irradiated fields. After wound creation, 100 μl of fibronectin hydrogel was topically applied on experimental wounds and 100 μl of phosphate-buffered saline (PBS) hydrogel was applied on control wounds. Standardized wound photographs were taken at weekly time intervals to calculate the percentage of wound closure relative to original wound size. Tissues isolated from the wound areas were evaluated histologically for wound healing quality and analyzed for gene and protein levels of radiation injury mediators with quantitative RT-PCR and ELISA.Results:Wounds treated with fibronectin hydrogel demonstrated significantly faster wound closure and decreased scarring than wounds treated with PBS hydrogel. On postoperative day 21, the mean percentage of wound area relative to original wound size was significantly higher in the control wounds (21.3% ± 2.8%) than in the fibronectin-treated wounds (4.7 ± 1.0%). By the experimental endpoint on postoperative day 28, the mean percentage of control wound area was 6.8% ± 2.9% while all fibronectin-treated wounds were fully healed. Picrosirius red staining demonstrated that the fibronectin-treated wounds had decreased total scar area (9.9 ± 3.0 mm2) compared to control wounds (38.1 ± 3.6 mm2). In addition, fibronectin hydrogel treatment was associated with decreased levels of radiation-induced inflammatory mediators. RT-qPCR of samples from fibronectin-treated wounds had significantly lower mRNA levels of TGF-β1 (0.45 ± 0.09) compared to levels in control wounds (1 ± 0.13). Similarly, RT-qPCR data revealed that relative mRNA levels of SMAD3 were significantly lower in fibronectin-treated wounds (0.34 ± 0.11) than in control wounds (1 ± 0.43). Lastly, protein level correlation with ELISA identified significantly lower TGF-β1 concentrations in fibronectin-treated wounds (2682 + 515.83 pg/mL) compared to control wounds (5244.5 + 700.08 pg/mL).Conclusion:Hydrogel-facilitated delivery of fibronectin significantly improved the rate and quality of wound healing in a porcine chronic irradiation wound model. Thus, this novel mechanism of fibronectin supplementation demonstrates potential for treating these otherwise nonhealing wounds.

Combined Treatment of Photobiomodulation and Arginine on Chronic Wound Healing in an Animal Model.

Introduction: Herein, the individual and combined effects of photobiomodulation (PBM) and arginine (ARG) on the wound healing course of an experimental model of a slow healing wound (ulcer) in rats were assessed. Methods: A total of 108 male rats were divided into 6 groups: control; lower energy density (low)-PBM; arginine ointment (ARG); low-PBM+ARG; high energy density (high)-PBM; and high-PBM+ARG. In each rat, one ischemic wound in the center of a bipedicle flap and one non-ischemic wound out of the flap were created. Both wounds were treated in the experimental groups. Microbial growth, wound area, and wound strength were assessed on days 0, 5, 10, 15, and 20 after wound infliction. Results: All non-ischemic wounds closed before day 15. High-PBM+ARG and ARG significantly increased wound closure rates compared to the control group (LSD test, P = 0.000, and P = 0.001, respectively) on day 10. All slow healing wounds were open on day 15 but closed completely before day 20. Low-PBM+ARG and high-PBM significantly increased wound strength (stress high load, SHL) on day 10 compared to the control group (LSD test, P = 0.001, and P = 0.000, respectively). ARG, high-PBM, and low-PBM+ARG significantly increased wound closure rates on day 15 relative to the control group (LSD test, P = 0.000, P = 0.000, and P = 0.001, respectively). Conclusion: High-PBM and low-PBM+ARG have biostimulatory and antibacterial effects on slow-healing wounds, which were shown by significant increases in wound closure rates, wound strength, and inhibition of Staphylococcus aureus growth.

Social, Legal and Economic Implications for the Implementation of an Intelligent Wound Plaster in Outpatient Care

Background:The care of chronic wounds is one of the core tasks of inpatient and outpatient care. The correct timing of changes has a significant impact on the positive course of wound healing. The VulnusMON project developed an intelligent wound plaster to determine the optimum time to change the plaster in hospital. Against the background of implementing the solution also in the outpatient sector, this article focuses on the following research questions: What is the legal framework for wound care in outpatient care? What are the differences in wound care between inpatient and outpatient care? What obstacles and barriers arise for the VulnusMON project when it is implemented in the outpatient sector? Can initial economic estimates be made for the transfer to the outpatient sector?Method:Due to the complexity of the different research questions, a mixed method design was used. The qualitative part of the study includes both focus groups and expert interviews. As part of the quantitative analysis, a data set on outpatient wound care was analyzed (n= 463).Results:In summary, it can be stated that the project VulnusMON and its intelligent wound plaster, which aims to determine the ideal time to change a wound plaster is viewed very positively by the professionals. However, there are a number of barriers that inhibit the potential transfer of the new digital solution to the outpatient setting. From an economic point of view, implementation in the outpatient sector makes sense, as travel times can be reduced. However, the study also points out important social implications, that pose several challenges for the actual transfer of the plaster to the outpatient sector.

CHANGES IN SUPERIOR DISPLACEMENT, ANGULATION, AND SHORTENING IN THE EARLY PHASE OF HEALING FOR COMPLETELY DISPLACED MIDSHAFT CLAVICLE FRACTURES IN ADOLESCENTS: RESULTS FROM A PROSPECTIVE, MULTICENTER STUDY

Background:Progressive displacement of diaphyseal clavicle fractures has been observed in adult patients, at times necessitating a change from non-operative to operative treatment. Whether this occurs in adolescent patients has not been well investigated.Purpose:The purpose of this study was to assess the rate and extent of progressive clavicle fracture displacement in adolescent patients following injury and during the early stages of healing.Methods:This was an IRB approved multi-center study evaluating prospective data that had previously been collected as part of a larger study evaluating the functional outcomes of adolescent clavicle fractures. A consecutive series of completely displaced diaphyseal clavicle fractures in patients age 10-18 years treated at one of three tertiary care pediatric trauma centers were included; all of which had standardized imaging within 2 weeks of the date of injury and throughout the course of healing (5-20 weeks post-injury). Measurements of clavicle shortening, superior displacement, and angulation were performed using validated techniques. Progressive displacement and/or interval improvement in fracture alignment were noted, as well as the subsequent need for surgical intervention. Patient demographic and radiographic parameters were assessed as possible risk factors for interval displacement.Results:One hundred patients met the inclusion criteria. The mean shortening, superior displacement, and angulation at the time of injury were 24 mm, 15 mm, and 7°, respectively. At a mean of 10 weeks post-injury, the fracture alignment improved across all three measurements for the overall cohort, with mean improvements in shortening of 15%, superior displacement of 15%, and angulation of 21% (Figures 1,2,3) Using a clinical threshold of a change in shortening or displacement of 10 mm or angulation of 10 degrees, 21% of fractures improved, 4% worsened, and 75% remain unchanged. Patients with more severe fractures were more likely to have improved alignment than less displaced fractures (p<0.001). No patient underwent surgical intervention for progressive displacement.Conclusions:Significant early improvements in fracture alignment were observed in a substantial percentage of adolescent patients with completely displaced clavicle fractures. Among the most severely displaced fractures, a 20% improvement in shortening and 50% improvement in angulation was identified. In 4% of cases, increased displacement was observed, but this tended to be mild, and in no cases did it prompt surgical intervention. This finding indicates that the true final deformity after an adolescent clavicle fracture is commonly less than that present at the time of injury.Figures:Figure 1.Figure 2.Figure 3.

PRECLINICAL TRIALS FOR ADVANCED CHITOSAN-BASED COATINGS IN TREATING PURULENT WOUNDS

Wound healing is a complex set of body responses to damaged tissues, which manifests itself through local destructive-inflammatory changes and general reactions. There are numerous coatings used currently in clinical practice to treat wounds. These coatings serve to develop a wet anti-bacterial environment, which is essential to facilitate the healing process. This work focuses on studying multifunctional coatings, which are based on chitosan, a biocompatible polymer featuring wound-healing properties. The distinctive feature to be found in chitosan fibers is their density and the orientation of pores. The coatings within this study were tested on scalped full-layer skin wounds of male Wistar-Kyoto rats and male rabbits. The sample with a dense structure and low biological resorption was found to be effective in performing the function of a framework, as well as in ensuring proper drainage at the affected area. This is important when treating purulent wounds. The experimental sample with a high degree of adhesion and a shorter biodegradation life can be recommended for treating wounds with no purulent-inflammatory issues, for granulating wounds, as well as a drug carrier-matrix. The studied wound coatings have revealed their medical efficiency at the preclinical stage (in vivo). Using wound coatings with specified structural and functional features would allow making a reasonable choice when selecting a coating depending on the stage of wound healing course.

Site-specific variation in the activity of COX-2 alters the pattern of wound healing in the tail and limb of northern house gecko by differentially regulating the expression of local inflammatory mediators

The role of COX-2 induced PGE2 in the site-specific regulation of inflammatory mediators that facilitate disparate wound healing in the tail and limb of a lizard was studied by analysing their levels during various stages of healing. The activity of COX-2 and concentration of PGE2 surged during the early healing phase of tail along with the parallel rise in EP4 receptor. PGE2-EP4 interaction is corelated to early resolution (by 3 dpa) of inflammation by rising the antiinflammatory mediator IL-10. This likely causes reduction in proinflammatory mediators viz., iNOS, TNF-α, IL-6, IL-17 and IL-22. Conversely, in the limb, COX-2 derived PGE2 likely causes rise in inflammation through EP2 receptor-based signalling, as all the proinflammatory mediators stay elevated through the course of healing (till 9 dpa), while expression of IL-10 is reduced. This study brings to light the novel roles of IL-17 and IL-22 in programming wound healing. As IL-17 reduces in tail, IL-22 behaves in reparative way, causing conducive environment for scar-free wound healing. On the contrary, synergic elevation of both IL-17 and Il-22 form a micro-niche suitable for scarred wound healing in limb, thus obliterating its regenerative potential.

Can Optimizing the Mechanical Environment Deliver a Clinically Significant Reduction in Fracture Healing Time?

The impact of the local mechanical environment in the fracture gap on the bone healing process has been extensively investigated. Whilst it is widely accepted that mechanical stimulation is integral to callus formation and secondary bone healing, treatment strategies that aim to harness that potential are rare. In fact, the current clinical practice with an initially partial or non-weight-bearing approach appears to contradict the findings from animal experiments that early mechanical stimulation is critical. Therefore, we posed the question as to whether optimizing the mechanical environment over the course of healing can deliver a clinically significant reduction in fracture healing time. In reviewing the evidence from pre-clinical studies that investigate the influence of mechanics on bone healing, we formulate a hypothesis for the stimulation protocol which has the potential to shorten healing time. The protocol involves confining stimulation predominantly to the proliferative phase of healing and including adequate rest periods between applications of stimulation.

Surgical Strategies to Promote Cutaneous Healing.

Usually, cutaneous wound healing does not get impeded and processes uneventfully, reaching wound closure easily. The goal of this repair process is to restore the integrity of the body surface by creating a resilient and stable scar. Surgical practice and strategies have an impact on the course of wound healing and the later appearance of the scar. By considering elementary surgical principles, such as the appropriate suture material, suture technique, and timing, optimal conditions for wound healing can be created. Wounds can be differentiated into clean wounds, clean–contaminated wounds, contaminated, and infected/dirty wounds, based on the degree of colonization or infection. Furthermore, a distinction is made between acute and chronic wounds. The latter are wounds that persist for longer than 4–6 weeks. Care should be taken to avoid surgical site infections in the management of wounds by maintaining sterile working conditions, using antimicrobial working techniques, and implementing the principles of preoperative antibiotics. Successful wound closure is influenced by wound debridement. Wound debridement removes necrotic tissue, senescent and non-migratory cells, bacteria, and foreign bodies that impede wound healing. Additionally, the reconstructive ladder is a viable and partially overlapping treatment algorithm in plastic surgery to achieve successful wound closure.

Long-Term Imaging of Wound Angiogenesis with Large Scale Optoacoustic Microscopy.

Wound healing is a well‐coordinated process, necessitating efficient formation of new blood vessels. Vascularization defects are therefore a major risk factor for chronic, non‐healing wounds. The dynamics of mammalian tissue revascularization, vessel maturation, and remodeling remain poorly understood due to lack of suitable in vivo imaging tools. A label‐free large‐scale optoacoustic microscopy (LSOM) approach is developed for rapid, non‐invasive, volumetric imaging of tissue regeneration over large areas spanning up to 50 mm with a depth penetration of 1.5 mm. Vascular networks in dorsal mouse skin and full‐thickness excisional wounds are imaged with capillary resolution during the course of healing, revealing previously undocumented views of the angiogenesis process in an unperturbed wound environment. Development of an automatic analysis framework enables the identification of key features of wound angiogenesis, including vessel length, diameter, tortuosity, and angular alignment. The approach offers a versatile tool for preclinical research in tissue engineering and regenerative medicine, empowering label‐free, longitudinal, high‐throughput, and quantitative studies of the microcirculation in processes associated with normal and impaired vascular remodeling, and analysis of vascular responses to pharmacological interventions in vivo.

A PROSPECTIVE STUDY ON CLOSED LATERAL INTERNAL SPHINCTEROTOMY IN CHRONIC ANAL FISSURES

Background: An anal fissure is a longitudinal rupture in the mucosa of the lower anal canal that results in slightbleeding when hard stool is passed and uncomfortable defecation. It is linked to the traditional trio of hypertrophypapilla, sentinel tag, and anal ulcer. Anal dilatation has been the conventional treatment for this prevalent issue—thepresent research aimed to determine the rate of complications, healing, and pain alleviation.Objective: to investigate the course of healing, pain management, and related consequences after a closed internalsphincterotomy for a persistent anal fissure.Material &amp; Methods: From July 2015 to June 2017, this research was carried out at the Mardan MedicalComplex Mardan at the Department of Surgery. The research included patients of either sex who had a persistentanal fissure. Patients with uncontrolled diabetes or on anticoagulant treatment, as well as those with a history ofsphincterotomy, anal dilatation, and suspicion of malignant fissure, atypical fissure, or ulcer with accompanying abscess, were not allowed to participate in the research. Every patient had a closed internal sphincterotomy, followed byfollow-up visits every two, six, and twelve weeks. Pre-made proforma were used to capture the data, and SPSS version16 was used for analysis. Frequencies and percentages were computed for qualitative variables, and for quantitativedata, mean and standard deviation.Results: 68 of the 71 patients who were admitted got full follow-up. A ratio of 1.6 to 1. 51 patients, or 75%of the total, reported discomfort during defecation; 37 patients, or 54%, reported bleeding, and 4 patients, or 6%,reported pruritis. A week after the operation, discomfort persisted in 2 patients (2.9%), whereas 66 patients (97%)had total pain relief in 24 hours. In two of the four patients, bleeding and hematoma wound infection were seen. Twoindividuals had transient flatus incontinence, but no faecal incontinence was seen. Within six weeks, the fissure hadcompletely healed in all 68 patients.Conclusion: When a chronic anal fissure is treated with closed lateral internal sphincterotomy, there is little chanceof complications and rapid symptom relief.Key Words: Fissure in ano, anal fissure, closed internal sphincterotomy, chronic anal fissure.

Differences in the magnetic resonance imaging parameter T2* may be identified during the course of canine patellar tendon healing: a pilot study.

Previous studies have utilized ultrashort echo (UTE) magnetic resonance imaging (MRI), and derived T2* maps, to evaluate structures with highly ordered collagen structures such as tendon. T2* maps may provide a noninvasive means to assess tendon damage and healing. This pilot study evaluated the longitudinal relationship of an induced mechanical strain on the patellar tendon with corresponding UTE T2* metrics, histologic and biomechanical evaluation at two post-operative time points. A total of 27 patellar tendons in male Beagles were surgically subjected to stretching by a small diameter (SmD) or a large diameter (LgD) diameter rod to induce damage due to strain, and evaluated at 4- and 8-week intervals using quantitative MRI (qMRI), biomechanical testing, and histology. A separate set of 16 limbs were used as controls. The tendons experienced a 67% and 17% prolongation of short T2* values as compared to controls at 4 and 8 weeks post-operatively, respectively. Histologic analysis displayed a trend of increased collagen disruption at 4 weeks followed by presence of greater organization at 8 weeks. Biomechanical evaluation found a reduction of tendon modulus and failure strain at both time points, and an increase in cross-sectional area at 4 weeks as compared to controls. These findings display tendon healing in response to an imposed strain and present the utility of qMRI to evaluate longitudinal differences of patellar tendon T2* values in a model of induced subclinical tendon damage. The qMRI technique of UTE provides a means to non-invasively evaluate the healing process of a mechanically damaged tendon.

Downstream Paclitaxel Released Following Drug-Coated Balloon Inflation and Distal Limb Wound Healing in Swine

The authors evaluated the presence of paclitaxel and healing of distal hind limb wounds created in 27 swine using biopsy punches followed by paclitaxel-coated balloon (PCB) use in the iliofemoral arteries of healthy swine. After 14 and 28days, no differences were seen in time course, appearance, and histopathology of wound healing between the single or triple PCB and uncoated balloon treatment despite clinically relevant paclitaxel concentrations in the skin adjacent to the healing wounds. Presence of paclitaxel downstream from the PCB treatment site does not impair the wound healing response of preexisting distal cutaneous lesions in healthy swine.

Research advances on mechanism of exosomes derived from adipose derived stem cells in the treatment of chronic wounds

Exosomes are a kind of membrane vesicle with a diameter of 30-150 nm. It is formed by the budding of multiple vesicles in cells, which can fuse with the cell membrane and be released into the extracellular matrix. Adipose derived stem cells (ADSCs) have the potential of self-renewal and multi-directional differentiation. They can transport the active substance, regulate the inflammatory response, cell migration, proliferation, differentiation and angiogenesis via the action of paracrine exosomes, so as to enhance the ability of wound repair, promote wound healing, and inhibit the formation of scars. Chronic wounds refer to the wounds that can not reach the anatomic and functional integrity through the normal, orderly, and timely repair process, and the course of the wound healing is more than 4 weeks. At present, there are various treatment methods for chronic wounds, among which ADSCs, although showing a good application prospect, have some limitations due to ethical issues, while exosomes can avoid this problem. This article reviews the treatment of chronic wounds with ADSC exosomes.

Correlational analysis of the regulatory interplay between molecules and cellular components mediating angiogenesis in wound healing under normal and hyperglycemic conditions.

The aim of this study was to correlate the content of cells with regulatory molecules associated with angiogenesis in wound healing in a rat model of hyperglycemia. We hypothesize that blood neutrophils are the main VEGF source and can stimulate FLT-1 receptor expression, which is the perquisite for efficient neoangiogenesis. Kinetic studies of the healing dynamics (3, 7, 14, 21 days) of burn wounds on the skin were conducted in white adult male rats. The content of nuclear factor kappa B (NF-κB), vascular endothelial growth factor (VEGF), its receptor (Flt-1) in the regenerated tissue was analyzed by western blot. Numbers of cells associated with the regenerative process and from peripheral blood (PB) were determined. Additionally a bone marrow (BM) myelogram was conducted. The relative number of peripheral blood (PB) neutrophils was found to be associated with the level of VEGF (R = 0.708) and Flt-1 (R = 0.472). The relative number of fibroblasts was also associated with VEGF (R = 0.562), but not with Flt-1. A negative association was found between the number of neutrophils in the regenerated tissue with VEGF (R = -0.454) and FLT-1 (R = -0.665). This confirms our hypothesis, that blood neutrophils are the main VEGF producer that stimulate the expression of the FLT-1 receptor subsequently inducing neoangiogenesis.Furthermore, that under hyperglycemic conditions fibroblasts were highly associated with VEGF (R = 0.800), while negatively associated with FLT-1 (R = -0.506). There was a high association between PB neutrophils and newly generated tissue cells: neutrophils (R = 0.717) and macrophages (R = 0.622), as well as the association between neutrophils and macrophages (R = 0.798). This is an indication of chronic inflammation and increased transmigration of blood cells to the burned tissue. Blood neutrophils are the main producer of VEGF and stimulate the expression of the FLT-1 receptor. In the context of hyperglycemia the imbalance of receptor and ligand associated with angiogenesis indicates for chronic inflammation: VEGF and FLT-1, which facilitates hypoxia, prevents the physiological course of burn wound healing and may be an important factor in impaired tissue regeneration in diabetes.

Nonhealing epithelial defect after collagen cross-linking for keratoconus with vernal keratoconjunctivitis

Here we report a case of nonhealing epithelial defect after corneal collagen cross-linking (C3R) in a 24-year-old young adult with progressive keratoconus and concomitant vernal keratoconjunctivitis (VKC). Epithelium off C3R with hypoosmolar riboflavin and ultraviolet -A irradiation was done in the right eye for progressive keratoconus. The preoperative minimum corneal thickness was 388 microns. Chronic VKC was stabilized with mast cell stabilizer and lubricants before C3R. The patient presented with nonhealing epithelial defect until 1-month post cross-linking due to possible limbal stem cell deficiency (LSCD) and underlying VKC with giant papillae. Amniotic membrane grafting was done twice for ocular surface stabilization which occurred at the end of 7 weeks. Final best-corrected visual acuity at 1 year was 6/12 with nebular corneal scarring. Preemptive management of giant papillae and proper stabilization of the ocular surface is essential before C3R. In cases of keratoconus with VKC, LSCD should be strongly suspected and reactivation of VKC with a prolonged course of epithelial healing can be a possible complication after C3R.

Role of Low-Level Laser Therapy as an Adjunct in the Management of Diabetic Ulcer

Diabetes mellitus (DM) is a chronic debilitating condition affecting people worldwide and diabetic foot ulcers are also a common problem. The treatment of diabetic ulcers requires a multimodal approach. Adjuvant low-level laser therapy (LLLT) may be useful in lesions with protracted healing course but the evidence is still limited. In this study, we share our experience regarding the use of low-level laser therapy as an adjuvant treatment modality in a patient with diabetic foot ulcer.

Conductive Materials for Healing Wounds: Their Incorporation in Electroactive Wound Dressings, Characterization, and Perspectives.

The use of conductive materials to promote the activity of electrically responsive cells is an effective means of accelerating wound healing. This article focuses on recent advancements in conductive materials, with emphasis on overviewing their incorporation with non-conducting polymers to fabricate electroactive wound dressings. The characteristics of these electroactive dressings are deliberated, and the mechanisms on how they accelerate the wound healing process are discussed. Potential directions for the future development of electroactive wound dressings and their potential in monitoring the course of wound healing in vivo concomitantly are also proposed.

Skin surface infrared thermography in pressure ulcer outcome prognosis

To assess the usefulness of skin surface infrared thermography (SSIT) as a prognostic tool in the treatment of stages III and IV pressure ulcers (PU), with hydrocolloid/hydrogel dressings plus 20 exposures to low-level laser therapy (LLLT), compared with hydrocolloid dressings alone, in a group of long-term bedbound care patients. In this comparative study, participants were randomly assigned to group I: PUs treated with specialist wound dressings and laser therapy, or to group II: PUs treated with specialist wound dressings without laser therapy. Thermal imaging sessions were carried out at the beginning of the study, and after two and four weeks of treatment. Thermal imaging processing was applied to compare percentage differences in the temperature distribution between the groups within selected regions of interest (ROIs). The correlation between the temperature distribution and PU healing was evaluated. A total of 43 patients took part. In the study, three variants of PU healing were observed: pure healing (H) with minimal granulation; healing with hypergranulation (H+G); and non-healing (NH). Analyses of SSIT-related thermographic patterns revealed their dependence on the course of healing. The percentage of successful PU healing reached 79.2% in group I compared with 73.7% in group II (p<0.05) The dominant variant of healing in Group I was H, while in group II the variants H and H+G were present with equal frequency. Thermal imaging processing allowed comparison of differences in the temperature distribution between the groups within ROIs. Application of LLLT significantly improved the healing process (p<0.05). The clinical significance of this finding should be confirmed with larger studies; however, SSIT may be useful as a prognostic tool during the treatment of PUs, with the ability to predict the course of healing initially, that is independent of LLLT treatment.

Bilateral Looser zones or pseudofractures in the anteromedial tibia as a component of medial tibial stress syndrome in athletes

PurposeMedial tibial stress syndrome (MTSS) represents a common diagnosis in individuals exposed to repetitive high-stress loads affecting the lower limb, e.g., high-performance athletes. However, the diagnostic approach and therapeutic regimens are not well established.MethodsNine patients, diagnosed as MTSS, were analyzed by a comprehensive skeletal analysis including laboratory bone turnover parameters, dual-energy X-Ray absorptiometry (DXA), and high-resolution peripheral quantitative computed tomography (HR-pQCT).ResultsIn 4/9 patients, bilateral pseudofractures were detected in the mid-shaft tibia. These patients had significantly lower levels of 25-hydroxycholecalciferol compared to patients with MTSS but similar levels of bone turnover parameters. Interestingly, the skeletal assessment revealed significantly higher bone mineral density (BMD) Z-scores at the hip (1.3 ± 0.6 vs. − 0.7 ± 0.5, p = 0.013) in patients with pseudofractures and a trend towards higher bone microarchitecture parameters measured by HR-pQCT at the distal tibia. Vitamin D supplementation restored the calcium-homeostasis in all patients. Combined with weight-bearing as tolerated, pseudofractures healed in all patients and return to competition was achieved.ConclusionIn conclusion, deficient vitamin D levels may lead to pseudofractures due to localized deterioration of mineralization, representing a pivotal component of MTSS in athletes with increased repetitive mechanical loading of the lower limbs. Moreover, the manifestation of pseudofractures is not a consequence of an altered BMD nor microarchitecture but appears in patients with exercise-induced BMD increase in combination with reduced 25-OH-D levels. The screening of MTSS patients for pseudofractures is crucial for the initiation of an appropriate treatment such as vitamin D supplementation to prevent a prolonged course of healing or recurrence.Level of evidenceIII.